Assessing vulnerability to panic:a systematic review of psychological and physiological responses to biological challenges as prospective predictors of panic attacks and panic disorder

Background Cognitive-behavioural theories of panic disorder posit that panic attacks arise from a positive feedback loop between arousal-related bodily sensations and perceived threat.In a recently develope computational model formalising these theories of pani attacks,it was observed that the response to a simulate perturbation to arousal provided a strong indicator of vulnerability to panic attacks and panic disorder.In this/review,we evaluate whether this observation is borne o in the empirical literature that has examined responses biological challenge(eg,C02 inhalation)and their relatio to subsequent panic attacks and panic disorder.Method We searched PubMed,Web of Science and PsycINFO using keywords denoting provocation agents(eg,sodium lactate)and procedures(eg,infusion)combined with keywords relevant to panic disorder(eg,panic).Articles were eligible if they used response to a biologic challenge paradigm to prospectively predict panic attac or panic disorder.Results We identified four eligible studies.Pooled effect sizes suggest that there is biological challenge response a moderate prospective association with subsequent pani attacks,but no prospective relationship with panic disorde Conclusions These findings provide support for the prediction derived from cognitive-behavioural theories an some preliminary evidence that response to a biological challenge may have clinical utility as a marker of vulnerab to panic attacks pending further research and developme Trial registration number 135908.

Towards a precision psychiatry approach to anxiety disorders with ecological momentary assessment:the example of panic disorder

Background Treatments for anxiety disorders are among the most effective in psychiatry.Yet,there is considerable room for improvement.Aim In this paper,we discuss the value of ecological momentary assessment as a research method and clinical tool.Methods We begin by describing ecological momentary assessment and its advantages,including the ability to collect ecologically valid information about mental disorders,in real time,in individual patients.We then illustrate the value of this approach for anxiety disorder treatment using two patients with panic disorder who completed ecological momentary assessments for 2 weeks before and after a cognitive-behavioural therapy intervention.We focus especially on two key pieces of information provided by ecological momentary assessment data:information about symptom dynamics and information about the relationships among symptoms as they unfold overtime within individual patients.Perspective Although considerable work is needed to further develop this methodology in the context of anxiety disorder treatment,we believe that these pieces of information may ultimately inform our understanding of how anxiety disorder treatments have their effect and how those treatments can be tailored to individual patients.